Reconstruction of Oncologic Tibial Defects in Children Using Vascularized Fibula Flaps

Background: Tibial resection in children presents a unique reconstructive challenge because of technical demands, future growth potential, and repetitive loading of the lower extremity. Positioned in a tibial defect, the free fibula undergoes primary bone healing while maintaining intrinsic resistance to infection and the ability to hypertrophy. The authors' aim was to evaluate surgical and functional outcomes in this selected group of pediatric patients. Methods: This is a retrospective review of 13 consecutive pediatric oncology patients who underwent reconstruction of segmental tibial defects with intercalated vascularized fibula flaps from 1992 to 2007. Perioperative and long-term complications were noted. Functional outcomes were analyzed. Results: Thirteen patients with a mean age of 12.6 years (range, 6 to 17 years) were included. Median follow-up was 63 months (range, 8 to 168 months). Overall survival was 77 percent. Flap survival was 100 percent. Perioperative local complication rate was 23 percent secondary to infection (two of 13 patients) and minor wound breakdown (one of 13 patients). Perioperative infection and chemotherapy did not significantly impact union or fracture rates. Hypertrophy of the fibula approached native tibial size in 90 percent of surviving patients. Median time to union was 10 months, average time to partial weight bearing was 5 months (range, 2 to 10 months), and time to full weight bearing was 16 months (range, 9 to 34 months). Of surviving patients, 91 percent achieved full weight bearing by 2 years, all of whom were ultimately able to participate in athletics. Conclusions: Functional reconstruction of segmental tibial defects in children can be achieved safely and reliably with the vascularized fibula. Infectious complications are low, but problems with union and fracture at this lower extremity site can be common until graft hypertrophy occurs. Those who achieve disease control may ultimately enjoy an active lifestyle. (Plast. Reconstr. Surg. 129: 195, 2012.)